Chiara Rafanelli1, Sara Gostoli2, Sara Buzzichelli3, Jenny Guidi2, Laura Sirri2, Pamela Gallo4, Enrica Marzola3, Serena Bergerone5, Gaetano Maria De Ferrari5, Renzo Roncuzzi6, Giuseppe Di Pasquale4, Giovanni Abbate-Daga3, Giovanni A Fava7. 1. Department of Psychology, University of Bologna, Bologna, Italy, chiara.rafanelli@unibo.it. 2. Department of Psychology, University of Bologna, Bologna, Italy. 3. Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy. 4. Division of Cardiology, Maggiore Hospital, Bologna, Italy. 5. Division of Cardiology, Internal Medicine Department, Città della Salute e della Scienza, University of Turin, Turin, Italy. 6. Division of Cardiology, Bellaria Hospital, Bologna, Italy. 7. Department of Psychiatry, University at Buffalo, Buffalo, New York, USA.
Abstract
INTRODUCTION: Randomized controlled trials (RCT) of psychotherapeutic interventions have addressed depression and demoralization associated with acute coronary syndromes (ACS). The present trial introduces psychological well-being, an increasingly recognized factor in cardiovascular health, as a therapeutic target. OBJECTIVE: This study was designed to determine whether the sequential combination of cognitive-behavioral therapy (CBT) and well-being therapy (WBT) may yield more favorable outcomes than an active control group (clinical management; CM) and to identify subgroups of patients at greater risk for cardiac negative outcomes. METHODS: This multicenter RCT comparedCBT/WBT sequential combination versus CM, with up to 30 months of follow-up. One hundred consecutive depressed and/or demoralized patients (out of 740 initially screened by cardiologists after a first episode of ACS) were randomized to CBT/WBT associated with lifestyle suggestions (n = 50) and CM (n = 50). The main outcome measures included: severity of depressive symptoms according to the Clinical Interview for Depression, changes in subclinical psychological distress, well-being, and biomarkers, and medical complications and events. RESULTS:CBT/WBT sequential combination was associated with a significant improvement in depressive symptoms compared to CM. In both groups, the benefits persisted at follow-up, even though the differences faded. Treatment was also related to a significant amelioration of biomarkers (platelet count, HDL, and D-dimer), whereas the 2 groups showed similar frequencies of adverse cardiac events. CONCLUSIONS: Addressing psychological well-being in the psychotherapeutic approach to ACS patients with depressive symptoms was found to entail important clinical benefits. It is argued that lifestyle changes geared toward cardiovascular health may be facilitated by a personalized approach that targets well-being.
RCT Entities:
INTRODUCTION: Randomized controlled trials (RCT) of psychotherapeutic interventions have addressed depression and demoralization associated with acute coronary syndromes (ACS). The present trial introduces psychological well-being, an increasingly recognized factor in cardiovascular health, as a therapeutic target. OBJECTIVE: This study was designed to determine whether the sequential combination of cognitive-behavioral therapy (CBT) and well-being therapy (WBT) may yield more favorable outcomes than an active control group (clinical management; CM) and to identify subgroups of patients at greater risk for cardiac negative outcomes. METHODS: This multicenter RCT comparedCBT/WBT sequential combination versus CM, with up to 30 months of follow-up. One hundred consecutive depressed and/or demoralized patients (out of 740 initially screened by cardiologists after a first episode of ACS) were randomized to CBT/WBT associated with lifestyle suggestions (n = 50) and CM (n = 50). The main outcome measures included: severity of depressive symptoms according to the Clinical Interview for Depression, changes in subclinical psychological distress, well-being, and biomarkers, and medical complications and events. RESULTS: CBT/WBT sequential combination was associated with a significant improvement in depressive symptoms compared to CM. In both groups, the benefits persisted at follow-up, even though the differences faded. Treatment was also related to a significant amelioration of biomarkers (platelet count, HDL, and D-dimer), whereas the 2 groups showed similar frequencies of adverse cardiac events. CONCLUSIONS: Addressing psychological well-being in the psychotherapeutic approach to ACS patients with depressive symptoms was found to entail important clinical benefits. It is argued that lifestyle changes geared toward cardiovascular health may be facilitated by a personalized approach that targets well-being.
Authors: Phillip J Tully; Deborah A Turnbull; John D Horowitz; John F Beltrame; Bernhard T Baune; Shannon Sauer-Zavala; Harald Baumeister; Christopher G Bean; Ronette B Pinto; Suzie Cosh; Gary A Wittert Journal: Front Psychiatry Date: 2022-04-14 Impact factor: 5.435
Authors: Sara Gostoli; Maria Montecchiarini; Alessia Urgese; Francesco Ferrara; Anna Maria Polifemo; Liza Ceroni; Asia Gasparri; Chiara Rafanelli; Vincenzo Cennamo Journal: Sci Rep Date: 2021-08-02 Impact factor: 4.379